α-氰基丙烯酸正丁酯黏合剂预防经皮椎体后凸成形术中骨水泥渗漏的效果

蔡进奎; 许海甲; 李伟康; 李漌涼; 肖智勇

doi:10.11659/jjssx.03E023070

您当前的位置：

首页 >

文章列表页 >

α-氰基丙烯酸正丁酯黏合剂预防经皮椎体后凸成形术中骨水泥渗漏的效果

临床研究 | 更新时间：2023-10-23

- α-氰基丙烯酸正丁酯黏合剂预防经皮椎体后凸成形术中骨水泥渗漏的效果
- Effect of N-butyl cyanoacrylate adhesive in preventing bone cement leakage during percutaneous kyphoplasty
- 局解手术学杂志 2023年32卷第10期页码：876-881
- 作者机构：
  
  武汉市第三医院骨科中心，湖北武汉 430074
- 作者简介：
  
  蔡进奎，E-mail：453369390@qq.com
- 基金信息：
  
  武汉市卫健委项目(S201912020032)
- DOI：10.11659/jjssx.03E023070
  中图分类号： R683.2;R687.3
- 纸质出版日期：2023-10-25，
  
  收稿日期：2023-03-13，
扫描看全文
蔡进奎,许海甲,李伟康等.α-氰基丙烯酸正丁酯黏合剂预防经皮椎体后凸成形术中骨水泥渗漏的效果[J].局解手术学杂志,2023,32(10):876-881.

CAI Jin-kui,XU Hai-jia,LI Wei-kang,et al.Effect of N-butyl cyanoacrylate adhesive in preventing bone cement leakage during percutaneous kyphoplasty[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(10):876-881.
蔡进奎,许海甲,李伟康等.α-氰基丙烯酸正丁酯黏合剂预防经皮椎体后凸成形术中骨水泥渗漏的效果[J].局解手术学杂志,2023,32(10):876-881. DOI： 10.11659/jjssx.03E023070.

CAI Jin-kui,XU Hai-jia,LI Wei-kang,et al.Effect of N-butyl cyanoacrylate adhesive in preventing bone cement leakage during percutaneous kyphoplasty[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(10):876-881. DOI： 10.11659/jjssx.03E023070.

摘要

目的

探讨α-氰基丙烯酸正丁酯（NBCA）黏合剂预防经皮椎体后凸成形术（PKP）中骨水泥渗漏的效果。

方法

选用80枚离体猪胸腰椎，经脱钙、力学机压缩椎体制作骨质疏松性椎体压缩骨折模型，按照随机数表法分为常规PKP组和胶水组，每组40枚；再根据骨水泥注射量的不同细分为高剂量组和低剂量组，每组20枚。常规PKP组采用传统手术方法行PKP，胶水组在骨水泥注入前先用自行设计的椎体裂隙喷涂工具进行NBCA预处理封闭椎体内裂隙，再注入骨水泥。统计椎体内骨水泥分布形态、骨水泥渗漏率和椎体骨水泥渗漏数量。

结果

胶水组和常规PKP组脱钙后骨密度在高剂量组和低剂量组组间及组内比较，差异均无统计学意义（

0.05）。胶水组和常规PKP组高剂量骨水泥注射弥散效果均优于低剂量骨水泥注射（

0.05），但是组间弥散效果等级比较，差异无统计学意义（

0.05）。胶水低剂量组骨水泥渗漏率低于常规PKP低剂量组（

0.05），胶水高剂量组骨水泥渗漏率低于常规PKP高剂量组（

0.05）。

结论

NBCA黏合剂预处理椎体不影响骨水泥在椎体内的弥散分布，能有效降低PKP术中骨水泥渗漏率，高剂量骨水泥弥散效果更好，但其渗漏风险也高。

Abstract

Objective

To explore the effect of N-butyl cyanoacrylate （NBCA） adhesive in preventing bone cement leakage during percutaneous kyphoplasty （PKP）.

Methods

A total of 80 isolated porcine thoracolumbar vertebrae were selected to make the osteopolitic vertebral compression fracture model by decalcification and mechanical machine compression，and then divided into the conventional PKP group and the glue group according to random number table method， with 40 pieces in each group. Each group was further divided into the high-dose group and the low-dose group according to different injection doses of bone cement， with 20 pieces in each subgroup.The conventional PKP group performed PKP using traditional surgical methods，and the glue group was pretreated with NBCA pretreatment to close the intravertebral fissures with a self-designed vertebral fracture spraying tool before the cement injection，and then injected with bone cement.The distribution pattern of bone cement in vertebral body， the leakage rate of bone cement and the number of bone cement leakage in vertebral body were counted.

Results

There was no significant difference in bone mineral density of the glue group and the conventional PKP group after decalcification between or within the high-dose group and the low-dose group （

0.05）. The diffusion effect of high-dose cement injection was better than that of low-dose cement injection in the glue group and the conventional PKP group (

0.05)

but there was no statistically significant difference in the diffusion effect between the groups (

0.05).The leakage rate of bone cement in the low-dose glue group was lower than that in the low-dose conventional PKP group (

0.05)

and the leakage rate of bone cement in the high-dose glue group was lower than that in the high-dose conventional PKP group (

0.05).

Conclusion

The pretreatment of vertebra with NBCA adhesive does not affect the diffusion distribution of bone cement in vertebra，which can effectively reduce the leakage rate of bone cement in PKP operation，and the diffusion effect of high-dose bone cement is better， but the leakage risk is also high.

关键词

经皮椎体后凸成形术椎体压缩骨折骨质疏松骨水泥渗漏α-氰基丙烯酸正丁酯

Keywords

percutaneous kyphoplastyvertebral compression fractureosteoporosisbone cement leakageN-butyl cyanoacrylate

references

Cheng X，Zhao K，Zha X，et al.Opportunistic screening using low-dose CT and the prevalence of osteoporosis in China：a nationwide，multicenter study［J］.J Bone Miner Res，2021，36（3）：427-435.doi：10.1002/jbmr.4187http://dx.doi.org/10.1002/jbmr.4187.

中国康复医学会骨质疏松预防与康复专业委员会.骨质疏松性椎体压缩骨折诊治专家共识（2021版）［J］.中华医学杂志，2021，（41）：3371-3379.doi：10.3760/cma.j.cn112137-20210625-01436http://dx.doi.org/10.3760/cma.j.cn112137-20210625-01436.

Zhan Y，Jiang J，Liao H，et al.Risk factors for cement leakage after vertebroplasty or kyphoplasty：a meta-analysis of published evidence［J］.World Neurosurg，2017，101：633-642.doi：10.1016/j.wneu. 2017.01.124http://dx.doi.org/10.1016/j.wneu.2017.01.124.

Noguchi T，Yamashita K，Kamei R，et al.Current status and challenges of percutaneous vertebroplasty （PVP）［J］.Jpn J Radiol，2023，41（1）：1-13.doi：10.1007/s11604-022-01322-whttp://dx.doi.org/10.1007/s11604-022-01322-w.

Schleicher P，Wengert A，Neuhoff J，et al.Cement augmentation in spinal surgery［J］.Unfallchirurgie （Heidelb），2022，125（6）：460-466.doi：10.1007/s00113-022-01188-7http://dx.doi.org/10.1007/s00113-022-01188-7.

Lv N，Feng X，Liu H，et al.Study on the influence of balloon dilation mode on the intravertebral cleft of osteoporotic fracture［J］.BMC Surg，2022，22（1）：351-356.doi：10.1186/s12893-022-01750-5http://dx.doi.org/10.1186/s12893-022-01750-5.

Vizzuso A，Barbieri S，Petrella E，et al.Prostatic artery embolization using n-butyl cyanoacrylate glue in patients with indwelling catheter［J］.Cardiovasc Intervent Radiol，2023，46（2）：295-298.doi：10.1007/s00270-022-03315-8http://dx.doi.org/10.1007/s00270-022-03315-8.

Higashino N，Sonomura T，Fukuda K，et al.Feasibility and safety of n-butyl cyanoacrylate-lipiodol-iopamidol as an alternative liquid embolic material［J］.Cardiovasc Intervent Radiol，2021，44（3）：482-488.doi：10.1007/s00270-020-02681-5http://dx.doi.org/10.1007/s00270-020-02681-5.

Picel AC，Koo SJ，Roberts AC.Transcatheter arterial embolization with n-butyl cyanoacrylate for the treatment of acquired uterine vascular malformations［J］.Cardiovasc Intervent Radiol，2016，39（8）：1170-1176.doi：10.1007/s00270-016-1328-zhttp://dx.doi.org/10.1007/s00270-016-1328-z.

Martino C，Salzano F，Martino D，et al.A prospective randomized trial of n-butyl-cyanoacrylate + metacryloxysulfolane adhesive versus suture alone for grafting in rhinoplasty：9 year follow-up［J］.Ann Otol Rhinol Laryngol，2021，130（5）：483-489.doi：10.1177/0003489420 943910http://dx.doi.org/10.1177/0003489420943910.

李志鲲.改良交叉穿刺椎体成形术治疗骨质疏松性椎体压缩骨折的生物力学分析及临床应用研究［D］.苏州：苏州大学，2020.doi：10.27351/d.cnki.gszhu.2020.003409http://dx.doi.org/10.27351/d.cnki.gszhu.2020.003409.

何保玉，刘宝戈，李学民，等.骨水泥弥散容积率在骨质疏松性椎体压缩骨折PKP术后疗效评价中的应用［J］.中国骨与关节杂志，2016，5（1）：68-73.doi：10.3969/j.issn.2095-252X.2016.01.015http://dx.doi.org/10.3969/j.issn.2095-252X.2016.01.015.

中华医学会骨科学分会.骨质疏松性骨折诊疗指南（2022年版）［J］.中华骨科杂志，2022，42（22）：1473-1491.doi：10.3760/cma.j.cn121113-20220704-00377http://dx.doi.org/10.3760/cma.j.cn121113-20220704-00377

Galibert P，Deramond H，Rosat P，et al.Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty［J］.Neurochirurgie，1987，33（2）：166-168.

Sebaaly A，Rizkallah M，Bachour F，et al.Percutaneous cement augmentation for osteoporotic vertebral fractures［J］.EFORT Open Rev，2017，2（6）：293-299.doi：10.1302/2058-5241.2.160057http://dx.doi.org/10.1302/2058-5241.2.160057.

杨惠林，刘强，唐海，等.经皮椎体后凸成形术的规范化操作及相关问题的专家共识［J］.中华医学杂志，2018，98（11）：808-812.doi：10.3760/cma.j.issn.2095-7041.2015.05.001http://dx.doi.org/10.3760/cma.j.issn.2095-7041.2015.05.001.

崔伟，熊小明，万趸，等.经皮椎体后凸成形术中使用明胶海绵减少骨水泥渗漏的可行性及临床疗效［J］.中华创伤杂志，2020，36（10）：899-904.doi：10.3760/cma.j.cn501098-20200603-00403http://dx.doi.org/10.3760/cma.j.cn501098-20200603-00403.

Sasaki K，Okada T，Yamaguchi M，et al.Major and minor complications of the pancreas after transcatheter arterial embolization using n-butyl-2-cyanoacrylate for acute bleeding from pancreatic arteries［J］.Jpn J Radiol，2022，40（3）：308-317.doi：10.1007/s11604-021-01203-8http://dx.doi.org/10.1007/s11604-021-01203-8.

Elsebaey MA，Tawfik MA，Ezzat S，et al.Endoscopic injection sclerotherapy versus n-butyl-2 cyanoacrylate injection in the management of actively bleeding esophageal varices：a randomized controlled trial［J］.BMC Gastroenterol，2019，19（1）：23-29.doi：10.1186/s12876-019-0940-1http://dx.doi.org/10.1186/s12876-019-0940-1.

Powell DK，Baum S.Bronchopleural fistula treated with n-butyl cyanoacrylate glue after ablation［J］.J Vasc Interv Radiol，2018，29（12）：1692-1693.doi：10.1016/j.jvir.2018.06.008http://dx.doi.org/10.1016/j.jvir.2018.06.008.

Moreno BM，Isaksson B，Nyman R，et al.Portal vein embolization with n-butyl-cyanoacrylate before hepatectomy：a single-center retrospective analysis of 46 consecutive patients［J］.Acta Radiol，2021，62（9）：1170-1177.doi：10.1177/0284185120953802http://dx.doi.org/10.1177/0284185120953802.

Asan Z，Kilitci A.Use of cyanoacrylate to prevent cerebrospinal fluid fistulas after cranial surgery［J］.Br J Neurosurg，2018，32（5）：544-547.doi：10.1080/02688697.2018.1494265http://dx.doi.org/10.1080/02688697.2018.1494265.

Sultan A，Mohamed A.Efficacy and safety of using n-butyl cyanoacrylate in cranial fixation following trauma and other pathologies［J］.Turk Neurosurg，2018，28（3）：416-420.doi：10.5137/1019-5149.JTN.20117-17.1http://dx.doi.org/10.5137/1019-5149.JTN.20117-17.1.

杨惠林，李茂，王根林，等.经皮椎体后凸成形术骨水泥渗漏相关问题［J］.中华解剖与临床杂志，2015（5）：377-378.doi：10.3760/cma.j.issn.2095-7041.2015.05.001http://dx.doi.org/10.3760/cma.j.issn.2095-7041.2015.05.001.

Chen C，Fan P，Xie X，et al.Risk factors for cement leakage and adjacent vertebral fractures in kyphoplasty for osteoporotic vertebral fractures［J］.Clin Spine Surg，2020，33（6）：251-255.doi：10.1097/BSD.0000000000000928http://dx.doi.org/10.1097/BSD.0000000000000928.

Chen W，Xie W，Xiao Z，et al.Incidence of cement leakage between unilateral and bilateral percutaneous vertebral augmentation for osteoporotic vertebral compression fractures：a meta-analysis of randomized controlled trials［J］.World Neurosurg，2019，122：342-348.doi：10.1016/j.wneu.2018.10.143http://dx.doi.org/10.1016/j.wneu.2018.10.143.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

“蛋壳”优化球囊成形技术在经皮椎体后凸成形术中的运用

骨填充网袋椎体成形术治疗新鲜骨质疏松压缩性骨折的临床疗效

经皮椎体成形术/经皮椎体后凸成形术后邻椎再骨折危险因素的Meta分析

3D打印辅助经皮穿刺椎体成形术治疗重度骨质疏松性椎体压缩骨折的疗效

骨质疏松性腰椎压缩性骨折的椎间盘和椎旁肌肉MRI变化及意义